Depression can complicate and slow recovery after a heart attack, not to mention the toll it can take on mental attitude, relationships, and happiness. In addition, new research has found that people who have been depressed after a heart attack are about 50% more likely to have a stroke than those who have not been depressed, according to a study presented at the 71 of the American College of CardiologySt Annual scientific meeting.
The study analyzed medical records of nearly half a million US patients after a heart attack, making it one of the largest ever to examine the link between depression and heart disease. The researchers found a marked difference in stroke rates between patients with and without depression, who otherwise had similar health and demographic backgrounds.
“The only difference between these two cohorts is that one has depression,” said Frank H. Annie, PhD, a research scientist in the Department of Cardiology at Charleston Area Medical Center in Charleston, West Virginia and the study’s lead author. “There could be a variety of factors related to depression that lead to these findings. What we are seeing in this data is very disturbing and we need to dig deeper to understand the causes and effects.”
Researchers used the Trinetx database to analyze the medical records of 495,386 patients who suffered a heart attack between 2015 and 2021. Trinetx consolidates electronic medical record data from 58 healthcare systems across the United States into a single, cloud-based service, enabling researchers to analyze multiple data sources while protecting patient privacy and security. Overall, about 51,000 patients (10.5%) were diagnosed with depression after their heart attack. Of these patients, about 1 in 6 were diagnosed with a mental disorder before their heart attack, while the others were not diagnosed with depression until after their heart attack.
For the study, Annie and colleagues compared the 51,000 patients with depression to a group of other heart attack survivors in the same dataset who were well matched on other characteristics but did not have depression. They found that 12% of people with depression and 8.3% of people without depression later had a stroke — a nearly 50% difference in stroke risk.
Annie said several factors could account for the difference. For example, depression can affect a person’s ability to attend medical appointments and take their medication. Depression can also affect sleep and focus, making it difficult to exercise regularly and maintain a heart-healthy diet.
In this study, Annie said that men are more likely to suffer from depression than women. Those with depression also tended to have higher rates of high blood pressure, coronary artery disease, diabetes, heart failure, and chronic obstructive pulmonary disease, as well as higher body mass index and a history of smoking. However, the association between depression and subsequent stroke remained significant even after accounting for these variables.
Previous studies have pointed to links between depression and heart disease. While the exact cause and effect of this relationship remains unclear, Annie says, there’s growing evidence that treating depression can help improve outcomes in people with heart disease. In this study, only 7% of patients with depression had used antidepressants.
“A multidisciplinary approach is required,” said Annie. “Based on this data, I would advocate that within the healthcare system, someone suffering from heart disease and depression should pay special attention to ensuring that these individuals keep their appointments and that they are seeing the right providers within the healthcare system.”
The researchers said more studies are needed to understand how depression and other factors can affect a person’s heart health and risk of stroke or other forms of heart disease.
“While we answer a few questions, we collect a lot more,” said Annie.
Annie will present The Effect of Depression on Post Myocardial Infarction Cases study virtually on Saturday, April 2 at 8:30 am ET / 12:30 pm UTC.
ACC.22 takes place April 2-4, 2022 in Washington, DC and brings together cardiologists and cardiovascular specialists from around the world to share the latest discoveries in treatment and prevention. follow @ACCinTouch, @ACCMediaCenter and #ACC22 for the latest news from the session.
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the college and its 54,000 members is to transform cardiovascular care and improve heart health. The ACC awards credentials to cardiovascular professionals who meet rigorous qualifications and are leaders in shaping health policies, standards and policies. The college also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC journals, operates national registries to measure and improve care, and offers cardiovascular accreditations to hospitals and institutions. For more information, see acc.org.
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